Geriatrics Flashcards
elderly patients are referred to greater than or equal to what age?
how can this be subdivided?
elderly = greater than or equal to 65
young-old (65-74)
old-old (75-84)
very old-old (85+)
by 2030, 1 in _____ US residents is expected to be greater than 65
1 in 5
what is the most rapidly growing age group in America?
adults 85 and older
true or false
the number of persons age 65 and older is expected to decline in coming years
FALSE - increase
what are the 5 “m’s” to remember for geriatric patients
Mobility
Mentation
Medication
What Matters
Multi-Complexity
what is the most important healthcare technology in preventing illness, disability, and death in the geriatric population?
medication
any symptom in an elderly patient should be considered what?
a drug side effect
(until proven otherwise)
true or false
it is possible for hospital admissions to be drug related
true
true or false
older adults are not at higher risk for adverse drug reactions as compared to young adults
FALSE - they’re 2-3 times at risk of an ADR
true or false
adverse reactions are more likely in older adults, but the outcomes are not significant as compared to younger adults
FALSE
the outcomes ARE more significant in older adults
true or false
medication related events is bad financially
true - costs around 528 billion a year and most occurs in older adults
what is the problem to consider when comparing the expected medication effects between a young adult and an older adult?
the dose of a given medication produces a different and sometimes unexpected response in an older patient
even if the same gender and similar body weight
true or false
if the gender and weight of a young person and old person are the same, their medication outcomes with the same dose of a drug given will likely be the same
FALSE
geriatric patients have a different and sometimes unexpected response
what is the “explanation” to the problem that geriatric patients produces a different and sometimes unexpected response to the SAME DOSE of a medication as a younger person?
there are pharmacokinetic and/or pharmacodynamic alterations with age
which explains the effect that a body has on a drug - pharmacokinetics or pharmacodynamics?
explain
pharmacokinetics
ADME
what does pharmacodynamic mean
the effect that the drug produces in the body, usually through binding to receptors
name 3 different types of absorption
gastrointestinal absorption
intramuscular absorption
transdermal (topical) absorption
the effect of drug-protein binding changes with age.
this is under which category of pharmacokinetics?
distribution
*which “piece” of pharmacokinetics is LEAST affected by aging
GI ABSORPTION
explain why GI absorption is the least part of pharmacokinetics that is affected by aging
due to decreased gastric emptying, there may be a delayed onset of action. However, this is really only clinically significant for acute drugs such as tylenol
chronic drugs are not really affected by this
therefore, there is not a significant change in the QUANTITY of drug absorbed, there just may be a delay in the drugs peak time or onset time
true or false
geriatric patients have increased GI motility
false - decreased GI motility, leading to prolonged absorption
true or false
geriatrics have decreased gastric emptying rate
true - this is what can delay the onset/peak time of acute drugs
true or false
geriatrics have increased intestinal blood flow
false - decreased
true or false
geriatrics have decreased intestinal surface area
true
**in geriatrics, as mentioned, GI absorption seems to be the least affected by aging.
which component of changes in GI absorption due to age is the MOST important? why?
decreased gastric acid output because we design drugs to dissolve in this acid. if there’s not enough of it, the absorption of the drug may not be good
name a drug that doesnt need an acidic environment to absorb
calcium citrate
true or false
elderly patients have decreased gastric pH
FALSE - increased
explain how IM absorption is affected by aging
possible decreased IM absorption because there is:
-decreased muscle mass (hard to find spot)
-decreased peripheral circulation (is the drug getting into blood)
-increased connective tissue (is drug getting into blood?)
explain how topical (transdermal) absorption changes with age
there is a concern with both the drug penetrating the skin and also if the drug does penetrate, is it even getting into the bloodstream
concern with no penetration due to decreased skin hydration and surface lipids, as well as increased keratinization
concern with getting into blood due to decreased peripheral circulation
thus, there is possible decreased absorption from transdermal patches with age
true or false
geriatrics have increased surface lipids
false - decreased
thus, penetration and thus absorption from transdermal patches may be affected
true or false
elderly patients have increased keratinization of the skin
true - penetration of skin through transdermal patches is a concern
explain how distribution changes with age
mostly a concern for lipid soluble drugs
elderly have increased body fat. thus, lipid soluble meds will be distributed to the fatty tissues. high Vd
true or false
age-related changes in drug distribution are not really a concern for water soluble meds
true
true or false
with age, there is a low Vd of water soluble medications
true
high Vd for lipid soluble medications due to increased fat. this is a problem in relation to the distribution portion of ADME
elderly patients have ______ cardiac output
how is this a concern?
decreased cardiac output
this is a concern with the distribution of the drug.
if a drug is being administered to relieve pain in the toes, there is a concern over whether the drug will even be DISTRIBUTED there due to decreased cardiac output compared to a young and healthy person
true or false
elderly patients have increased body water
false - decreased
how does protein binding change with age and why is this a concern
there is DECREASED serum albumin
this means that drugs that are highly protein bound like phenytoin and warfarin, will have an INCREASED free fraction in the bloodstream (because not bound to albumin) and thus more easily toxic
true or false
geriatrics have decreased protein affinity
true
true or false
geriatrics have increased alpha1-acid glycoprotein
true
name 2 highly protein bound medications
phenytoin
warfarin
both metabolism and elimination of drugs are affected by age.
which is more significant?
renal elimination
explain how drug metabolism is affected by age
there is decreased hepatic mass and bloodflow
phase 1 reactions (oxidation/reduction/hydrolysis) are DECREASED
phase 2 (conjugation) is UNCHANGED as well as CYP450 activity
enzyme induction/inhibition is controversial
true or false
drugs that are metabolized via phase 1 enzymes are preferred for geriatric patients
FALSE
phase 1 metabolism activity is DECREASED with age
drugs metabolized via phase 2 are preferred
true or false
CYP450 activity is unchanged in elderly populations
true
true or false
geriatrics have both decreased renal blood flow and decreased renal tubular secretion
TRUE
true or false
geriatrics have increased GFR and thus decreased creatinine clearance
FALSE
decreased GFR and thus decreased creatinine clearance
explain how estimating renal function may be more difficult in elderly patients
creatinine is made by muscle.
elderly have decreased muscle mass and thus are making much less creatinine than a young person
thus, it can be easy to look at blood levels and see low creatinine and think renal function is fine, but must remember that they are making much less to begin with
true or false
elderly may have stable serum creatinine, even if kidney function is poor
true - due to increased muscle mass and thus making less creatinine to begin with
the average renal function of an 80 year old is ~____% of a 20 year ofd?
around 50%
older drugs used creatinine clearance as a measure to determine renal dosing
newer drugs use what?
eGFR (estimated glomerular filtration rate)
what equation is used to estimate creatinine clearance?
Cockcroft-Gault equation
memorize formula?
memorize formula?
